Authorised Signatory Form

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1 Form Complete this form: to give a person other than your adviser the authority to act on your existing margin lending facility in all matters as if they were you (including but not limited to increasing the loan, buying and selling investments and changing your contact details, but excluding the receipt of margin calls on your behalf.) Your nominated authorised signatory must be an Australian resident for tax purposes and reside in Australia; or if you wish to change/revoke this authority. Section 1 Borrower(s) Name of borrower(s) on the St.George Margin Lending Facility Borrower(s) Client Reference Number Section 2 Request Section 3 Remove the Existing Section 4 New I/We request you to (Please tick ( ) one) Add an authorised signatory to my/our margin loan account - complete sections 4 and 6. Remove the existing authorised signatory from my/our margin loan account - complete sections 3 and 6. Name of existing authorised signatory Please provide us with a copy of the authorised signatory s identification as per the Proof of Identification in the Appendix of this form. Name of Title Surname Given Name(s) in full of Birth Driver licence number State of issue / / Residential address PO Box not accepted Suburb State Postcode Country Daytime Phone Number Mobile Phone Number address Relationship to Borrower(s) Current employment status Full-time Part-time Casual/temporary/contractor Self-employed Other Please specify Occupation (if self-employed, describe nature of business) STGW /15 Page 1 of 6

2 Form Section 4 New (continued) Section 5 Privacy Statement I confirm that the above details are true and correct. of authorised signatory 7 / / For more than one authorised signatory, please attach an additional sheet to your application. The personal information we collect from you on this form will be used to identify and appoint you as an. We and members of the Westpac Group will use or disclose your personal information to contact you or send you information about other products and services offered by the Westpac Group or its preferred suppliers. Our privacy policy available at st.george.com.au, contains information about how we handle your personal information. Please call us on if you do not wish to receive marketing material from us. Section 6 Declaration and Signing I/We authorise the person(s) identified as the New in Section 4 to act on my/our behalf in relation to the my/our margin lending facility. I/We authorise the revocation and/or changes to my/our existing authorised signatory as identified in this form. By signing below, you consent to the collection, use and disclosure of your personal information in accordance with the St.George Privacy Statement available at stgeorge.com.au. Where you have provided information about another individual, you must make them aware of that fact and the contents of the St.George Privacy Statement. Our privacy policy, available at stgeorge.com.au or by calling , contains more information about how we handle your personal information. First Borrower Second Borrower 7 7 / / / / Company Borrower or Company Trustee In all cases, either two directors, one director and one secretary or the sole director/secretary must sign. Company Director Company Director/Secretary (if applicable) Office Held Office Held 7 7 / / / / Please send the completed form and photocopies of relevant required identification to: St.George Margin Lending, Reply Paid 1467, Royal Exchange NSW 1224 Office Use Only Actioned By Reviewed By / / / / STGW /15 Page 2 of 6

3 Appendix Proof of Identification Proof of Identification A. Proof of Identification and Certification of Identity Documents for Individuals All St.George margin lending applicants (including individuals, individual trustees, company directors/guarantors, beneficial owners and authorised signatories), must provide certified copies of identification documents in accordance with the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 (AML/CTF Act 2006). Note: It is an offence under the AML/CTF Act 2006 to knowingly provide false or misleading information or knowingly produce a false or misleading document. Penalty: Imprisonment for 10 years. This document details acceptable identification documentation for all persons/entities as mentioned above, who are a party to this St.George Margin Loan Facility. Please consult the relevant sections that apply to you. Refer to this section if you are: An individual/sole trader and/or joint individual borrower An authorised signatory An individual trustee for a trust borrower A company director beneficial owner of a company or trust structure. If any of the above persons are noted on the St.George Margin Loan Application, they must provide original certified copies of acceptable identification documentation by an approved certifier. Your identification documents can be certified by either: 1. Your financial adviser where they have introduced you to this St.George Margin Loan Facility, have an Australian Financial Services Licence (AFSL) and 2 or more continuous years of service with one or more licensees. Your financial adviser must complete the appropriate IFSA Identification Form and attach it to this St.George Margin Lending Loan Application. 2. Any other eligible certifier as listed in the Certified Identification Form (CID) for Individuals which is attached (see Categories of acceptable certifiers). Your certifier must complete this form and attach it to this St.George Margin Lending Loan Application together with the certified identification documents. If you are unable to provide the required identity documents, contact our Account Management Team on for further options. B. Proof of Identification and Certification of Identity Documents for Trusts Refer to this section if the borrower is a trust. Where the trustee is an individual/s, please also refer to Section A above. Where the trustee is a corporate, the company directors must also refer to Section A above. Trustee borrowers must provide an original certified copy of the dated and stamped (where applicable) trust deed. Your copy of the trust deed can be certified by either: Your financial adviser where they have introduced you to this St.George Margin Loan Facility, have an AFSL and 2 or more continuous years of service with one or more licensees. Your financial adviser must complete the appropriate IFSA Identification Form and attach it to this St.George Margin Lending Loan Application together with the original certified identification documents. Any other eligible certifier as listed below: 1. A person who is enrolled on the roll of the Supreme Court of a State or Territory, or the High Court of Australia, as a legal practitioner (however described) 2. A judge of a court 3. A magistrate 4. A chief executive officer of a Commonwealth Court 5. A registrar or deputy registrar of a court 6. A notary public (for the purposes of the Statutory Declaration Regulations 1993) 7. A police officer 8. An Australian consular officer or an Australian diplomatic officer (within the meaning of the Consular Fees Act 1955) 9. A member of the Institute of Chartered Accountants in Australia, CPA Australia or the National Institute of Accountants with 2 or more years of continuous membership 10. An officer with 2 or more continuous years of service with one or more financial institutions (for the purposes of the Statutory Declaration Regulations 1993) 11. A Justice of the Peace 12. An agent of the Australian Postal Corporation who is in charge of an office supplying postal services to the public 13. A permanent employee of the Australian Postal corporation with 2 or more years of continuous service who is employed in an office supplying postal services to the public 14. A finance company officer with 2 or more continuous years of service with one or more finance companies (for the purpose of the Statutory Declaration Regulations 1993) 15. An officer with, or authorised representative of, a holder of an Australian financial services licence, having 2 or more continuous years of service with one or more licensees 16. Any person specifically appointed as our agent to certify identity To certify an identity document: The certifier will need to print their name, date and qualification/occupation which makes them an eligible certifier on each photocopied document. The certifier must include the following statement on each photocopied document I certify that this is a true copy of the original document. Photocopies of certified documents will not be accepted. The original certification and signature of the certifier must be visible. If you need any assistance, please contact our Account Management Team on for further options. STGW /15 Page 3 of 6

4 Certified Identification Form (CID) Verified by Certifier for an Individual Identification ONE Primary Photographic document from Group 1 or if unable to; ONE Primary Non Photographic document from Group 2 and one Secondary document from Group 3 The combination of documents certified must contain full name and date of birth. All documents must be current unless specified otherwise Group 1 Primary Photo Australian passport (can either be current or expired within the last 2 years but must not be cancelled, defaced or mutilated)^ Foreign passport issued by a foreign government, the United Nations or an agency of the United Nations (must not be cancelled, defaced or mutilated)^ Foreign travel document issued by a foreign government, the United Nations or an agency of the United Nations^ Australian licence/permit (can either be a driver s licence, learner s permit)^ Foreign driver s licence which contains a photograph^^ Proof of age card issued by a State or Territory (or equivalent)^ National identity card issued by a foreign government, the United Nations or an agency of the United Nations^ ^must contain photograph and signature ^^must contain photograph and/or signature Group 2 Primary Non-Photo Full Australian birth certificate (or extract) issued by State/Territory Registry of Births, Deaths and Marriages Full Foreign birth certificate issued by a foreign government, the United Nations or an agency of the United Nations Australian citizenship certificate Citizenship certificate issued by a foreign government Centrelink pension card (Australian) Note: Certifiers are to certify legible copies of the documents provided from the above documents listed and also provide certifier details on the next page. STGW /15 Page 4 of 6

5 Certified Identification Form (CID) Verified by Certifier for an Individual Group 3 Secondary A financial benefits notice issued by the Commonwealth or a State/Territory within the last 12 months and includes the customer s name and residential address (e.g. a notice from Centrelink) Australian Taxation Office (ATO) notice issued within the last 12 months and includes the customer s name and residential address Utilities notice issued by a local government or utilities provider within the last 3 months and includes the customer s name and residential address Foreign driver s licence which does not contain a photograph Department of Veterans Affairs pension concession card (Australian) A current tenancy/lease agreement (must not be cancelled or expired) Medicare card Australian Marriage certificate issued by State/Territory Registry of Births, Deaths and Marriages ^^must contain photograph and/or signature Identification card issued to a student at an Australian higher education institution (TAFE or University)^^ Notice issued by the principal of a school (must be less than 3 months old, include the name of the customer, residential address, period of school attendance and issued on a school letterhead) A current card issued under a Commonwealth, State, or Territory law for the purpose of identification, for a government service, or as a licence Note: Certifiers are to certify legible copies of the documents provided from the above documents listed and also provide certifier details on the next page. STGW /15 Page 5 of 6

6 Certified Identification Form (CID) Verified by Certifier for an Individual and signature of Individual to be identified CIS No. (if known) Account number (if known) Account Name Individual (name in full) Individual s Certifier s and Declaration Note to Certifier: Please ensure copies are legible and record the following on each copy of the identification provided. This is a true copy of an original or certified copy document provided ; then print and sign your name, date and Qualification No. (if applicable) and also provide your details below so that we may contact you if necessary to confirm this information. Certifier s Declaration I certify that: 1. The person named above signed this form in my presence. 2. I sighted originals of the documents noted on reverse of form. 3. I am satisfied that the documents produced were genuine and that to the best of my knowledge they confirm the name, address and/or date of birth of the person named above. Category No. of acceptable certifier (see list below) Qualification No. (if applicable) Full Name of Certifier Title First Name Family Name Residential address PO Box not allowed Daytime Contact Number Country Code Area Code Number Privacy Statement The personal information we collect from you on this form will be used to identify the individual named above. We and members of the Westpac Group will use or disclose your personal information to contact you or send you information about other products and services offered by the Westpac Group or its preferred suppliers. Our privacy policy, available at st.george.com.au or by calling , contains information about how we handle your personal information. Categories of acceptable certifiers 1. A person enrolled on the Roll of the Supreme Court of a State or Territory, or the High Court of Australia, as a legal practitioner (however described). 2. A judge of a court. 3. A magistrate. 4. A chief executive officer of a Commonwealth court. 5. A registrar or deputy registrar of a court. 6. A notary public (for the purposes of the Statutory Declaration Regulations 1993). 7. A police officer. 8. An Australian consular officer or an Australian diplomatic officer (within the meaning of the Consular Fees Act 1955). 9. A member of the Institute of Chartered Accountants in Australia, CPA Australia or the National Institute of Accountants with two or more years of continuous membership. 10. An officer with two or more years of continuous service with one or more financial institutions (for the purposes of the Statutory Declaration Regulations 1993). 11. A Justice of the Peace. 12. An agent of the Australian Postal Corporation who is in charge of an office supplying postal services to the public. 13. A permanent employee of the Australian Postal Corporation with two or more years of continuous service who is employed in an office supplying postal services to the public. 14. A finance company officer with two or more years of continuous service with one or more finance companies (for the purposes of the Statutory Declaration Regulations 1993). 15. An officer with, or authorised representative of, a holder of an Australian financial services licence, having two or more years of continuous service with one or more licensees. 16. Any person specifically appointed as our agent to certify identity. Note: Non-residents certification by the following acceptable certifiers categories numbered 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 as equivalent within the certifier s country of residence. Branch/Office Use Only Employee Name Employee No. Branch Name Branch No. Certified documents and this Certified Identification form must be attached to your form. STGW /15 Page 6 of 6

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